11

The Shoulders

THE DESIGN OF THE SHOULDER JOINT makes it vulnerable to injury unless we strengthen the internal muscles, primarily the rotators, but also some parts of the larger muscles. Since the joint is designed to move through such a wide range of motion, it is held together by soft tissues: ligaments, tendons, and muscles. The joints are shallow and not tightly connected. So the design that makes it possible for us to do all those amazing things with our arms also makes the shoulder susceptible to tension (overworked muscles) and injury.

The most important aspect of shoulder health is the relationship between the head of the arm bone and the joints (see fig. 11.1 below). For a well-functioning shoulder and also to correct a lot of neck problems, you need to be able to keep the head of the humerus (the upper arm bone) within the confines of the shoulder joint, especially when you lift and carry things. The sequence in the chain of movement of any shoulder action should be small internal muscles engage first, then the back. If you are lifting anything, learn to pull in the head of the bone first and then engage whatever other muscles you need.

I would say most shoulder problems and a lot of neck tensions would be prevented completely if this were the case. So if you don’t do anything else for your upper body, do the following exercises, which not only help to support the head of the humerus, but also increase your ability to sense when the bone slips out, so you can consciously pull it back in.

Fig. 11.1. Shoulder and rotator cuff muscles

  Shoulder Joint Exercise

Look at the structure of the shoulder first, and then try this movement.

1. Keeping your arms straight in front of you, lift them up to a 60-degree angle, as though lifting something light (fig. 11.2). Notice what happens to the shoulder blade in the back, especially at the bottom tip. Does it lift up with the arm or drop down?

 

Fig. 11.2. Shoulder Joint Exercise

        If the whole shoulder blade lifts up with the arm, bringing your shoulder closer to your ear, you are using your upper trapezius to lift. You can see this pattern of development: the upper back looks somewhat collapsed and weak, or rounded and overstretched, and the upper shoulder muscles feel hard and tight. This way of lifting can be useful if you must lift a heavy weight; otherwise it’s an inefficient and counterproductive action. It’s a habit people get into when they have a shoulder injury, since it saves pressure on the joint, but when the arm bone is no longer moving separately from the scapula, the small muscles that control that movement weaken.

2. Now swing the arms loosely up and down, using momentum. Swing them one at a time, then together. Can you feel the movement of the bone in its socket? Imagine it, looking at fig. 11.1, so you can visualize where that movement should occur. As the arm lifts, the scapula drops in the back, without the back ribs shifting at all. Notice any difference in the two sides, and see if you can let the arm that moves less easily learn from the more differentiated one.

3. Now raise the arms up to 90 degrees. Keep them completely straight and rigid; don’t let your elbows bend, but also do not hyperextend your elbows. Move the arms straight back behind you. Keep them in their sockets, and experiment with raising them as though you are lifting something. Make sure your neck stays back and is relaxed, that your jaw hangs loose, and your front ribs stay back.

4. Swing the arms now. Probably you won’t have to think much about keeping the head of the arm bone in, so let the movement be loose and free. Notice the difference. When you lift objects, envision your shoulders as a girdle, equal front and back, supported by your rib cage, with the mobile arm/shoulder joint as the focus of movement. This will prevent that ubiquitous shoulder tension. Keeping the awareness of the bottom tip of the shoulder blade and its position on the rib cage may help center your focus.

  Exercise for Shoulder Alignment

This exercise will help to correct rounded, internally rotated shoulders; tight chest; “winged” shoulders that do not lie flush on the back. It corrects muscle imbalance in the rhomboids (weak and loose), serratus anterior (tight, weak, or strong), and pectoralis minor (tight, probably weak).

1. Bring your palms over your ears at a right angle to your forearm (fig. 11.3). Engage the bottom of the shoulder blades to pull both shoulders down, and keep them dropped (you will have to keep thinking about this). Make sure both shoulders are even and your head is in line with the spine. Gaze straight ahead or slightly upward.

2. Now keep the alignment and draw the elbows back as far as you can. Make sure the upper arm comes back with them.

Fig. 11.3. Exercise for Shoulder Alignment

3. Engage the muscles between the shoulder blades (rhomboids) tightly; squeeze hard. Use these muscles to press the shoulders down farther.

4. Hold this, and check your position—head in line, palms pressed into ears, shoulders even and down, chest open, back straight. Try to bring the inner wrists to the ears.

To modify: Take the same position, but this time bring the wrists away from the ears as far as you need to, keeping the fingertips on the sides of your head. Hold as long as you can.

EXTERNAL ROTATION OF THE SHOULDER

Most of us greatly overuse the internally rotating (forward) muscles of the shoulder, because almost all the activities we do are forward facing. Driving, writing, manual labor, and even exercise all involve forward movements of our shoulders. Any activity that takes place in front of us and demands that we use our hands will require forward rotation, because our eyes are in the front of our bodies. Jumping rope is the only everyday activity I can think of that uses external rotation.

The hunched-over look most of us acquire as we get older comes from this chronic forward rotation and leads to shoulder tension as the large muscles of the shoulder and upper back get overextended and weak and struggle to pull back the shoulder joints. Massage and stretching will help temporarily, but to effect a permanent change we need to strengthen our external rotator cuff muscles and rhomboids.

  Reposition the Shoulder Joint

To reposition the shoulder joint, experiment with externally rotating your arms. Internal rotation means turning the arm from the thumbs up to the shoulder in toward the center; external rotation is turning them outward in the opposite direction. In the first part of the exercise you can work with one arm at a time or with both at once, spiraling from the fingertips into internal and external rotation.

1. Standing or sitting, let the arms dangle at your sides. Then rotate the arms externally, away from the body, as though the thumb of each hand was drawing a small circle on the floor. If there were a clock on the floor, just below your hands and facing up to the ceiling, the right hand would make a clockwise movement and the left hand would move counterclockwise. Make sure your arms move equally from the thumb up, and the back and neck stay still. Go as far as you can with the external rotation. Now, turn the arms the other way, in toward the body. Feel how the shoulder joint rotates outward when the arm makes an internal rotation. Make sure your back and neck stay still and your collarbones face straight ahead.
2. Externally rotate your right arm as far as you can; then bend at the elbow, keeping the rotation. The hand will be about nipple level.
3. Keeping the rest of your body still—no arching of the back, which is what you will probably want to do—bring the right elbow forward toward the front of the room. Then take that elbow in your left hand and pull it forward and up and as far as you can. Experiment with the angle of the forearm and the distance of the elbow from the body for a good stretch.
4. Very slightly bend your body forward for a deeper stretch. You want to feel all the movement and sensation in the shoulder joint. It is quite possible for the elbow to rotate all the way up and over to your back—this advanced stretch is a part of some yoga positions. Most of us can’t do that (and don’t force it), but use the image and possibility of that amount of freedom in the joint to open the area up fully. You may find that changing the distances between the upper arm and the body and the angle of the forearm gives you a better stretch.
5. Repeat with the left arm.

  Rotator Cuff Muscle Exercise

This one is great, worth all the trouble, because it stretches and strengthens the whole rotator cuff with the shoulder girdle in correct alignment. But it does take some setting up.

1. You’ll need a mirror initially, or someone to spot you. Stand with your back to a wall, a mirror (or your spotter) in front of you. Bring your legs away from the wall so only your hips, shoulders, and spine and the back of your head touch the wall—if something doesn’t touch, or is uncomfortable, use padding.
2. Then bring your arms up to shoulder height, palms down, pressing as much of the back of your upper arm into the wall as you can (fig. 11.4). Your wrists, elbows, and shoulders are in one line. Gaze straight ahead.
3. Then bend your elbows so the wrists and forearms form a right angle with the upper arms, palms facing downward. Your wrists and hands stay in line with your elbows, the knuckles in line with the wrists. You can hold a one- to three-pound weight if you want or you can strengthen and align with this exercise without using any weights. You should start without any weights to get the hang of the alignment.
4. Keep your wrists in line with your elbows, and the elbows the same distance from the head, as you bring your hands very slowly down, keeping a perfect right angle—that’s the hard part. Watch for the elbows dropping down (press back into the wall with your upper arms the whole time); the hands moving closer in or farther away from the right angle; and your shoulders or head moving away from the wall.

Fig. 11.4. Rotator cuff muscle exercise

5. Press back into the wall as you bring your hands down, watching the wrist/ knuckle alignment (keep wrists straight) at the bottom. Feel a good stretch at the bottom of the move, hold a few seconds, and then come up to your starting position slowly. Each repetition should take about 30 seconds. Repeat 3 to 5 times.

  Shoulder Stretch Series

Shoulder Stretch I

1. Lie on your stomach, head toward a wall. Bring your elbows to the wall, directly in line with your shoulders, hands up the wall (see fig. 11.5). Your wrists should line up with your shoulders—they may not do this easily, so make sure both wrists are even in relation to the elbows and shoulders—and press down hard into the wall at the inside of the wrist, thumb, and index finger; the forearms will rotate slightly internally. The upper arms and shoulders will then rotate externally, opening the armpits toward the floor.

Fig. 11.5. Shoulder Stretch I

        To intensify this stretch, keep your elbows on the wall, press the forearms and hands against the wall, and scoot the rest of your body away from the wall. Rest your head wherever it feels comfortable. If you get someone to press gently on your upper back in this position, you will feel even more of a shoulder stretch.

2. Now, from the same starting position (more or less, depending on the length of your neck and where you want your head in the stretch), bring your arms straight up the wall, chest off the floor slightly. Elbows and wrists must be in line, collarbone straight so shoulders are even. The unmodified version has the elbows on the wall, forearms pressing in, and head dropped. To modify, use yoga blocks to support your elbows, at any height, leaving a gap, so your head can drop in between (fig. 11.6). You can rest your head on the wall if this is uncomfortable. Make sure you keep your wrists, thumbs, and index fingers pressing into the wall.
    Let the upper spine drop in between the shoulders, relaxing and softening it into the stretch as deeply as you can. You will probably feel the stretch in the shoulder joint, deep inside the structure. It will intensify as gravity pulls your head and torso toward the ground, so start from a position that you can hold for at least a minute without tensing your body. Allow the stretch to open the chest and diaphragm, breathing throughout the entire rib cage.

Fig. 11.6. Shoulder Stretch I Modification A

3. Make sure your lower back is relaxed, unclench your buttocks, and pull the tailbone toward your feet. If your lower back will not disengage, you can do the same stretch kneeling, facing the wall and working with your psoas until you can relax the pelvis in this position (fig. 11.7).

Fig. 11.7. Shoulder Stretch I Modification B

Follow with any forward bend—the Wall Hang Stretch is ideal.

Shoulder Stretch II

1. Stand two to three feet away from the wall, back to the wall, arms above your head, wrists on the wall, palms flat on the wall, and fingers pointing straight down to the floor (fig. 11.8).

Fig. 11.8. Shoulder Stretch II

        If you can’t do this, you can use a shelf behind you, if you can find one the right height. Place the inside wrist and palm under the shelf and press against the shelf for leverage. It’s hard to see if your hands are even. You can look at your elbows, aligning their positions, and bring them toward your body. This will tend to even up the hand position. The elbows will want to splay out away from you, and the success of this stretch will depend on how far you can engage your triceps to bring them in. You could tie your upper arm muscles in this way with a yoga strap.

2. Now push your palms hard against the wall or the bottom of the shelf, keeping elbows pressed in and lifting your sternum. Don’t—very important—arch your lower back at all. This is not a backbend, and you could hurt the back this way. Your head should stay forward. Think of the collarbones lifting up and toward the ceiling and away from the wall, elbows squeezing in tightly, and shoulder blades pulling in toward each other, supporting and lifting your chest and shoulders.

Shoulders and Upper Chest Stretch

1. Bring the front of your right shoulder to the wall, arm straight out along the wall behind your body, elbows bent a little or a lot, whatever feels best to you. Turn your body away from the arm and shoulder, trying to keep the shoulder on the wall, or as close to it as possible (fig. 11.9). Repeat with the left shoulder. You will feel a stretch in the chest and shoulder, maybe in the arm.

Fig. 11.9. Shoulders and Upper Chest Stretch

2. Use the hand that’s not on the wall to gently pull the other side of your rib cage away from the shoulder. This is a free-form stretch, so experiment with the elbow position—more or less bent, higher or lower on the wall—and the body position—hips turned farther, chest turned farther—for a variety of sensations.

To modify: Use a corner or a doorjamb or put padding between your shoulder and the wall. If the shoulder or elbow hurts, it is best to modify this exercise by bringing that shoulder toward the ear. This will isolate the stretch in pectoralis minor. Breathe in the upper outer portion of the lungs.